2 differnt doctors biling same DOS

mad_one80

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Hi,

I'm a little confused! Ok, I have a patient that came in to see one of my doctors and then that doctor refers the patient to another (same group, same specialty) for a consult and I&D. Can I bill the f/u for Dr. A and consult with I&D for Dr. B on the same DOS? Why or why not?
This confuses me since I was told that if a patient comes in for E/M with a NP for counseling(regarding family history or being a possible genetic carrier, etc) and then is seen by the doctor (to discuss further surgery options) after the visit with NP on the same DOS, only one E/M can be billed(under the Dr as preferredd to billing under NP) and also using prolonged E/M codes if applicable. :confused:
Any explanations or supporting documentation/info is soooo greatly appreciated! Thanks for all your time!!
 

halebill

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Your physician's will need to agree on which one gets to bill the visit. Per the Medicare Claims Processing Manual section 30.6.5 - Physicians in Group Practice:
Physicians in the same group practice who are in the same specialty must bill and be paid as though they were a single physician. If more than one evaluation and management (face-to-face) service is provided on the same day to the same patient by the same physician or more than one physician in the same specialty in the same group, only one evaluation and management service may be reported unless the evaluation and management services are for unrelated problems. Instead of billing separately, the physicians should select a level of service representative of the combined visits and submit the appropriate code for that level.
 

mad_one80

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Your physician's will need to agree on which one gets to bill the visit. Per the Medicare Claims Processing Manual section 30.6.5 - Physicians in Group Practice:
Physicians in the same group practice who are in the same specialty must bill and be paid as though they were a single physician. If more than one evaluation and management (face-to-face) service is provided on the same day to the same patient by the same physician or more than one physician in the same specialty in the same group, only one evaluation and management service may be reported unless the evaluation and management services are for unrelated problems. Instead of billing separately, the physicians should select a level of service representative of the combined visits and submit the appropriate code for that level.

BUT doesnt it also state...
"Consultations requested by members of same group
It is appropriate for one physician or qualified NPP in a group practice requests a consultation from another physician in the same group practice when the consulting physician or qualified NPP has expertise in a specific medical area beyond the requesting professional’s knowledge. A consultation service shall not be reported on every patient as a routine practice between physicians and qualified NPPs within a group practice setting."

i'm just confused since both doctors have the same specialty but one hasnt performed the I&D for over 8 years so she sent the consult to the other doctor along with an I&D. Not sure if that qualifies billing for both f/u and consult (2ND OPINION about future surgery option, differnt dx than I&D)/I&D on the same DOS for different MD's in the same group or not...thanks.
 
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Who decided the I&D needs to be done?

I do not think there is any consult here.

If Dr A saw the patient and determined that an I&D was required, but Dr A doesn't do that, so Dr A sends the patient to Dr B in the same office for the I&D ...

Dr B will code ONLY the I&D and no E/M service (the RVU for the procedure inculdes the E/M required for this procedure). Dr A will code the appropriate level of E/M service with a -25 modifier (since they are in the same practice, they'll be treated as one physician, so would need the separately identifiable E/M modifier).

F Tessa Bartels, CPC, CEMC
 
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